Long-term impact of celebrity suicide
on suicidal ideation: results from a population-based study
Background: The short-term effect
of celebrity suicide
on the overall suicide rate is widely
known, but long-term effects remain unclear.
Objective: To examine whether celebrity
suicide is associated with suicidal ideation over a longer period. Design: This is a study on the effect
of the suicide of a famous Hong Kong entertainment celebrity, who committed
suicide on 1 April 2003, on suicide thoughts of the community. A
population-based survey was conducted between December 2003 and July 2004.
Respondents were asked about their suicidal ideation, psychological well-being,
life events, and whether or not they had been affected by celebrity suicide.
Setting: Hong Kong Special
Administrative Region, the People's Republic of China. Participants: 2016 respondents aged between 20 and 59 years.
Results: After controlling for some
known suicide risk factors, celebrity suicide was shown to be independently
associated with suicidal ideation. People who had indicated to have been
affected by celebrity suicide were 5.93
times (95% CI 2.56% to 13.72%, p = 0) more likely to have severe level of
suicidal ideation (Adult Suicidal Ideation Questionnaire score [>, double
=]31) than people who had not been affected. Respondents having greater anxiety
symptoms, less reason for living and more focus on irrational values were also
found to have had their suicide ideation affected by celebrity suicide.
Conclusions: Celebrity suicide is a
risk factor for suicidal ideation over a short term as well as over a long
term. Raising awareness of the possible negative effect of celebrity suicide
through suicide prevention programmes in the community is needed.
Teks lengkap:
Current evidence
shows an association between celebrity suicides or death and a subsequent
increase in the suicide rate. 1- 4
In addition, media coverage of suicide cases may influence suicidal
behaviour in others, as well as the choice of the suicide method. 5- 7 Also, studies measuring
the effects of celebrity suicides are more likely to find an imitation effect
than studies of non-celebrity suicides. 6
However, existing
studies have methodological limitations. Most of the results are derived from
aggregated data and are subject to the limitations of ecological fallacy. 4, 8 Furthermore, most of the
research focuses on the short-term effect, say 2-4 weeks after the incidence. 1, 2, 9 Limited information is
available regarding whether or not media reporting on celebrity suicides may
influence an individual's suicidal thoughts over the longer term. 10 Also, it suggests that
celebrity suicides affect vulnerable people the most. This suggests that the
influence of celebrity suicide is not an independent risk factor, but could be
mediated by other risk factors for suicide. 8, 11 Hence, whether or not a celebrity suicide is
an independent risk factor for suicidal ideation is still uncertain.
Hong Kong's
famous pop star Mr Leslie Cheung had depression and died by jumping from a
height on 1 April 2003. His death generated extensive media coverage that might
have prompted suicidal thoughts in others. After 8-15 months, a
population-based household survey was conducted to study suicidality in Hong
Kong between December 2003 and July 2004. The aim of the survey was to gauge
respondents' views about their level of suicidal ideation, psychological
well-being, life events, and whether or not they had been influenced by the
celebrity suicide.
In this paper, three hypotheses
were examined in relation to the celebrity suicide:
(H1) The long-term influence of
celebrity suicide was associated with suicidal ideation.
(H2) The
long-term influence of celebrity suicide was an independent risk for suicide
ideation after controlling for other known risk factors.
(H3) Some risk
factors would have a moderating effect on the impact of celebrity suicide on
suicidal ideation. Note that the "long-term" is referring to the
period from 8 months to 15 months.
METHOD
Design
This
population-based study adopted a two-wave longitudinal household survey design.
The results reported in this paper were obtained from the first wave. A
two-stage, stratified random sampling method was also used. The sampling frame
was the Frame of Quarters maintained by the Census and Statistics Department,
Hong Kong SAR Government, and was the most complete and updated register of
residential addresses in Hong Kong. Households were selected randomly from the
Frame of Quarters, and one household member was then randomly selected to
participate in the study. This study was approved by the ethics committee of
the Faculty of Social Science, The University of Hong Kong, Hong Kong, China.
The survey was
the first community-based survey to study the prevalence rate of suicidal
behaviour in Hong Kong. From previous literature, life-time suicidal thought
from nine countries was estimated to be 18.5%. 12 We expected that the rate of suicidal ideation
in Hong Kong was a bit higher and that it might range from 25% to 35%. If
precision level was within 2%, with 95% level of confidence, the sample size
was estimated to range from 1800 to 2185.
During the data
collection, 2016 people aged between 20 and 59 years participated in the study
with 955 (47.4%) and 1061 (52.6%) of them being men and women, respectively.
Table 1 gives the sample age-gender distribution. The subject pool contact
rate-that is, the percentage yielding a successful contact with valid
households-was 87%, and the response rate was 62% of those who were contacted.
Given a sensitive survey topic like suicidal behaviour, the response rate was
considered satisfactory. Other population-based surveys in Hong Kong on less
sensitive topics typically obtain similar response rates. 13 There was no significant
difference in age and gender distribution between the sample and the population
at large. The precision level of the estimate of suicidality in the sample is
around ±2.2%.
Table 1 Sample distribution by age and gender
Age group (years)
|
Gender
|
Total
|
Men
|
Women
|
<25
|
Count
|
99
|
114
|
213
|
% within gender
|
10.4%
|
10.7%
|
10.6%
|
25-39
|
Count
|
367
|
448
|
815
|
% within
gender
|
38.4%
|
42.2%
|
40.4%
|
40-59
|
Count
|
489
|
499
|
988
|
% within gender
|
51.2%
|
47.0%
|
49.0%
|
Total
|
Count
|
955
|
1061
|
2016
|
% within gender
|
100.0%
|
100.0%
|
Face-to-face
interviews were held, and each interview lasted for about 45-60 min.
Self-report booklets were also used for sensitive questions. All questions were
administered in Chinese and the interview was conducted in Cantonese, the most
common language in Hong Kong, as 90% of the population spoke Cantonese.
Before the field
work, a pilot study was conducted to test the wordings of the questionnaire and
the translated instruments. Feedbacks from the pilot, such as ambiguous
wordings or misunderstanding, were corrected and rectified.
Data collection field work was
carried out between 1 December 2003 and 4 July 2004. All interviewers were
trained on how to
administer the interview, particularly on how to handle cases in which
respondents were an imminent suicidal risk or requested professional help.
During the fieldwork stage, follow-ups were carried out by clinical staff for
those cases where the respondent required consultations or referral services.
The research team also carried out independent quality control measures
continuously over the data collection period, including appraisals, telephone
interviews with randomly selected respondents and reviews of completed
questionnaires.
Measures
Influence
of celebrity suicide
The influence of
celebrity suicide was measured by two questions asked in a self-report booklet.
Respondents were asked about their level of distress brought on by a celebrity
suicide: "Have you ever been disturbed by the news of a celebrity suicide?"
(question A). There were five response categories: "very disturbed",
"somewhat disturbed", "moderately disturbed", "a
little disturbed" and "no disturbance at all".
The second
question investigated their possible mindset change after a celebrity suicide:
"Did you change the way you view suicides following a celebrity
suicide?" (question B). They could choose their responses from among the
four choices-namely, "Suicide is more acceptable than what I had
previously thought", "Suicide is more acceptable than what I
previously thought and it spurred my own suicidal thoughts as well",
"Suicide is less acceptable than what I had previously thought" and
"No change".
The coding scheme was as follows:
if question A was not answered as "no disturbance at all" or question
B was answered either as "Suicide is more acceptable than what I had
previously thought" or as "Suicide is more acceptable than what I had
previously thought and it spurred my own suicidal thoughts as well", the
influence of the celebrity suicide was coded as "Yes". Otherwise, it
was coded as "No". The question is very specific in examining the
effect and the extent of whether celebrity suicide has any effect on the
respondent.
Positive thinking after celebrity suicide
One choice in
question B was "Suicide is less acceptable than what I had previously
thought" and this could be understood as a positive effect from celebrity
suicide. If the influence of celebrity suicide was coded as "No" and
Question B was answered as "Suicide is less acceptable than what I previously
thought", the positive thinking after a celebrity suicide was coded as
"Yes". Otherwise, it was coded as "No".
Suicidal ideation
Suicidal
ideation-Adult Suicidal Ideation Questionnaire (ASIQ) 14 -was a 25-item self-report measure of the
severity of suicide ideation. The scale incorporated a 7-point item response
format on which the respondents noted their frequency of occurrence of suicidal
ideation during the past month. It was used for a sample of people aged >20
years. The range of scores was from 0 to 150. The cut-off score of [= or >,
slanted]31 suggested a severe level of suicidal thought. Evidence of
reliability and validity of the scale was reported for the community of adults
and college student samples. 14 The
scale was also forward and backward translated from English to Chinese by two
bilingual clinical psychologists. The Chinese version of the ASIQ showed
excellent internal reliability (Cronbach's α = 0.98). A significant correlation
between ASIQ and anxiety, hopelessness and prior suicide attempts (0.34, 0.27
and 0.31, respectively) was found to support convergent validity. Its validity
was further confirmed by a significant difference in ASIQ mean score between
suicide attempters and non- attempters (t = 4.25, p<0.001). The instrument
ASIQ was translated into Chinese with the permission of the Psychological
Assessment Resources (Odessa, Florida, USA).
Demographic characteristics
Basic demographic characteristics
of the respondents (ie, age and gender), were reported.
The following risk
and protective factors for suicide were included as control variables. The used
instruments were obtained from either author or public domain.
Anxiety
Anxious symptoms in the week
before the interview were measured by the 7-item anxiety subscale of
Depression
Anxiety Stress Scales. 15 Anxiety
was suggested to be a risk factor for suicide attempt. 16 The Chinese version of Depression Anxiety
Stress Scales used in this study was a valid assessment of anxiety among the
Chinese-speaking population. 17 This
subscale had good internal reliability (Cronbach's α = 0.82). The summary score
ranged from 4 to 28, with higher scores indicating higher levels of anxious
mood states during the past week.
Hopelessness
The 20-item
Chinese version of the hopelessness scale (C-HOPE) 18 was used
to measure hopelessness, which has been demonstrated as an important predictor
of suicidal behaviour. 19 Hopelessness
was found to be a significantly stronger indicator of suicidal risk than
depression. 20 The C-HOPE used in this study was
shown to be moderately correlated with depressive and psychiatric symptoms in
Chinese college students, revealing good internal reliability (Cronbach's α =
0.85). 18
Reasons for living
The 12-item Brief
Reasons for Living (BRFL) Scale, answered on a 6-point scale, was used to
measure a range of beliefs potentially important as reasons for not committing
suicide. 21 The six
subscales of the BRFL scale were as follows: responsibility to family, moral
obligations, child-related concerns, fear of social disapproval, survival and
coping beliefs, and fear of suicide. Again, the scale was forward and backward
translated from English to Chinese by two bilingual clinical psychologists. The
Chinese version of the BRFL showed good internal reliability (Cronbach's α =
0.77). Its validity was supported by a significant difference in the scale's
mean score between people who had thought about suicide in the past 12 months
and people without this ideation (t = 5.43, p<0.001).
Irrational values
The Irrational
Values Scale was a 9-item scale to measure endorsement of irrational values
that would lead to emotional disorders. 22 The score was based on a 9-point Likert-type
scale. The scale was forward and backward translated from English to Chinese by
two bilingual clinical psychologists. The Chinese version of this scale showed
fairly good internal reliability (Cronbach's α = 0.77). Its significant
correlation with anxiety supported convergent validity (r = 0.31).
Impulsivity
The Plutchik
Impulsivity Scale was used to measure the level of impulsivity found to be
associated with suicidal risk. 23 Six
items from the original scale were selected to assess the tendency to engage in
impulsive behaviours such as deliberate self-harm or suicide. 24 The scale was forward and
backward translated from English to Chinese by two bilingual clinical
psychologists. The internal reliability of the abbreviated scale was found to
be satisfactory (Cronbach's α = 0.68). Significant differences of the scale's
mean scores between suicide attempters and non-attempters was found to support
its validity (t = 5.84, p<0.001).
Prior suicide
attempt
Prior suicide
attempt behaviour was investigated by the following question: "Have you
attempted suicide in the past 12 months?" It was a dichotomous measure
requiring either a Yes or a No response.
A question on
psychiatric history, "Have you ever received psychiatric treatment?"
(received psychiatric treatment), was also asked. It was a dichotomous measure
with Yes or No as the response.
Negative life events
Respondents were
asked "Have you ever been abused physically, mentally or sexually?"
(Abuse history), "Have you had severe interpersonal conflicts over the
past 12 months?" (Interpersonal conflicts), "Do you have a debt
problem (excluding mortgage)?" (Debt problem) and "Do you have
chronic illness or pain?" (Health problem). All of these questions were
dichotomous, requiring either a Yes or a No response.
Statistical analysis
SPSS V.12.0 was
used for all statistical analyses in this paper. The level of significance was
chosen to be p<0.05. Moreover, a bivariate logistic regression was used to
examine the age-gender-specific associations to
the influence of
celebrity suicide. A multiple linear regression was also used to test the
nested model, with suicide ideation as a dependent variable measured by an ASIQ
score and adopting the forward enter approach method. Hierarchical regression
was then applied to test the effects of entering the influence of celebrity
suicide (step 1), known risk and protective factors for suicide (step 2) as
well as potential moderators for the model (step 3). Statistical tests were
carried out to assess the significance of the standardised coefficients. In the
proposed model, we use standardised coefficients rather than dichotomised
variables of the covariates to examine the effects on ASIQ in order not to lose
information and statistical power due to dichotomisation of continuous
variables. The effects on some of the risk and protective factors of
suicidality can be found in another paper. 25 The
primary interest of this paper is to examine the effect of celebrity death on suicidality
in the presence of other covariates. All continuous variables in those
cross-product terms were mean-centred to minimise co-linearity in moderator
test. 26 A Variance
Inflation Factor (VIF) was used to diagnose the severity of the co-linearity.
If VIF was <10, it indicated that no severe co-linearity was present in the
model. 27 In order to obtain
clinically and epidemiologically useful results, a binary logistic regression
model was also established.
Sensitivity
analysis was then conducted to assess whether the non-response bias may have
any effect on the analysis.
RESULTS
Descriptive statistics
In total, 38%
(767/2016) of the respondents admitted to the experience of being influenced by
a celebrity suicide. About 43.4% (460/1061) of women and 32.1% (307/955) of men
had been influenced by celebrity
suicide, and this difference was
significant (χ
2 =
26.8, p = 0). A significant difference was detected among
1
different age groups (χ2 = 7.6, df = 2, p = 0.02)-that is,
people aged 40-59 years (35.1%, 347/988) were less
likely to be influenced than
groups aged <25 years (38.5%, 82/213) and 25-39 years (41.5%, 338/815).
Table 2 shows the
age-gender-specific relationship. By treating the influence of celebrity
suicide as a dependent variable, a bivariate logistic regression was used to
examine the age-gender-specific relationship. After stratification by gender,
we observed that men aged 25-39 years had a significantly higher risk of being
influenced by a celebrity suicide than those aged 40-59 years. No other
age-gender group showed any significant relationship.
Table 2 ORs for the influence of celebrity suicide on age groups of
both genders, a bivariate logistic regression
Age group(years)
|
Men
|
Women
|
OR (95% CI)
|
p Value
|
OR (95% CI)
|
p Value
|
<25
|
1.10(0.69% to 1.76%)
|
0.68
|
1.17(0.78% to 1.76%)
|
0.45
|
25-39
|
1.38(1.03% to 1.84%)
|
0.03
|
1.22(0.94% to 1.58%)
|
0.13
|
40-59
|
1.00
|
1.00
|
A multiple
regression for suicidal ideation
The multiple
linear regression model was fitted to test the relationship between suicide
ideation and the influence of celebrity suicide. Suicide ideation measured by
ASIQ was treated as a dependent variable. Since the distribution of the
suicidal ideation was not normal, a log transformation was performed to
normalise this distribution. The influence of celebrity suicide was entered
into the model as an independent variable at step 1. The standardised
coefficient of the influence of celebrity suicide was found to be significant.
In fact, the influence of celebrity suicide explained 4% of the variance of
suicidal ideation. This result supported hypothesis H1, implying that influence
of celebrity suicide was associated with suicidal ideation.
To rule out the possibility that the influence of celebrity suicide
indirectly exerted an effect on suicidal ideation-
that is, whether it was mediated by other risk factors for suicide anxiety
symptoms, hopelessness, reasons for living, impulsivity, irrational values, prior
suicidal behaviour, received psychiatric treatment and negative life
events (abuse
history, debt problem, health problem and interpersonal conflicts) were entered
into the model as control variables at step 2. This forward entering approach
was used for the multiple linear regression. After all variables had been
entered into the model, the proportion of missing cases was 1.6%. Table 3 gives
the results of a multiple linear regression, stepwise change of R 2 as well as the standardised
coefficients at steps 1 and 2. Table 3 Hierarchical
regression for significant cross-product terms included in suicidal ideation
Predictors
|
R2 change at step*
|
β at step 1
|
β at step 2
|
Final β
|
Step 1: Enter influence of celebrity suicide
|
Influence
of celebrity suicide
|
0.04
|
0.20[dagg
er]
|
0.14[dagg
er]
|
0.14[dagger]
|
Step 2:
Enter risk and protective factors for suicide[double dagger]
|
Anxiety
symptoms
|
0.27
|
0.20[dagg
er]
|
0.13[dagger]
|
Hopelessness
|
0.13[dagge
r]
|
0.11[dagg
er]
|
Reason
for living
|
-0.12[dagger]
|
-0.06[dagger]
|
Prior
suicide attempt
|
0.19[dagg
er]
|
0.18[dagg
er]
|
Received psychiatric treatment
|
0.05[dagger]
|
0.05[dagge
r]
|
Abuse
history
|
0.11[dagg
er]
|
0.11[dagger]
|
Debt problem
|
0.05[dagge
r]
|
0.05[dagg
er]
|
Interperso nal conflicts
|
0.16[dagger]
|
0.14[dagger]
|
Step 3:
Enter cross- product terms
|
Anxiety
symptom x Influence of celebrity suicide
|
0.02
|
0.09[dagger]
|
Reason
for living x Influence of celebrity suicide
|
-
0.13[dagge
r]
|
Irrational
values x Influence of celebrity suicide
|
0.08[dagg
er]
|
Although the
known risk factors for suicide had been controlled, the standardised
coefficient for the influence of celebrity suicide was found to be significant
at step 2. Moreover, all VIF statistics were found to be <10, which
suggested no severe co-linearity. The results supported the hypothesis H2 that
celebrity suicide was an
independent risk
for suicide ideation after controlling for other known risk factors. Test for
moderator
Hierarchical
regression was used to study the effects of potential moderators for the
influence of celebrity suicide. Cross-product terms of the influence of
celebrity suicide and their potential moderators (including all the previously
described control variables) were entered at step 3 and a backward elimination
method was used.
Only significant
cross-product terms yielded by hierarchical regression were re-entered into the
model. Table 3 shows the stepwise changes of R 2 and the
final standardised coefficient at step 3.
From these
results, having more anxiety symptoms, less reason for living and more
reinforcement of irrational values were found to moderate the effects of the
influence of celebrity suicide on suicidal ideation. These cross- product terms
helped to explain the additional 2% of variance in suicidal ideation. The
results supported hypothesis H3, implying that some risk factors have some
moderating effect on the effect of celebrity suicide on suicidal ideation.
Positive thinking
after celebrity suicide
Among the 2016
respondents, 68 people were not disturbed by the news of a celebrity suicide
and answered "Suicide is less acceptable than what I had previously
thought". We defined this group as having "positive thinking after
celebrity suicide". Among this group, 29 were men and 39 were women. No
gender differences were observed (χ 2 =
0.63, p = 0.252). All 68 people had no indication of severe suicidal
ideation-that is, their ASIQ scores were lower than the cut-off score of 31. If
we treated positive thinking after celebrity suicide as a dependent variable
and controlled for age and gender, the logistic regression showed that
impulsivity (OR 0.93, 95% CI 0.86% to 0.99%; p = 0.04) and whether the
individual had health problems (OR 1.77, 95% CI 1.04 to 3.00; p = 0.03) were
associated with their positive effect after the celebrity suicide.
Clinical and
epidemiological implication
A binary logistic
regression model was established to obtain clinically and epidemiologically
useful results. As suggested by Reynolds gives the results after controlling
for some known suicide risk factors; people who had been influenced by
celebrity suicide were 5.93 times (95% CI 2.56% to 13.72%, p = 0) more likely
to have a severe level of suicidal ideation (ASIQ score[>, double =]31) than
people who had no such influence. However, the results were slightly different
from those shown in table 3, as some variables (received psychiatric treatment,
abuse history and debt problem) had become insignificant in the logistic model
due to the reduction in power resulting from dichotomising the ASIQ scores.
Table 4 Binary logistic regression model for suicidal ideation,
Adult Suicidal Ideation Questionnaire
Predictors
|
B
|
Exp (B)
|
Sig.
|
Influence of celebrity suicide*
|
1.78
|
5.93
|
0
|
Anxiety symptoms[dagger]
|
0.15
|
1.16
|
0
|
Hopelessness[dagger]
|
0.07
|
1.07
|
0
|
Reason for living[dagger]
|
-0.07
|
0.93
|
0
|
Prior suicide attempt[double dagger]
|
1.41
|
4.10
|
0.019
|
Interpersonal conflicts§
|
0.80
|
2.22
|
0.048
|
Sensitivity
analysis
Sensitivity analysis 28 was
conducted to assess whether the non-response bias may affect the significance
of the result. We consider the situation that there are dissimilarities of
prevalence of suicidal ideation, due to the non-response bias, between the
response and non-response groups in both being influenced by the celebrity
suicide group (influence group in short) and not being influenced by the
celebrity suicide group (non-influence
group in short).
Then we examine the scenarios that could give a smaller estimated overall OR.
If the estimated overall OR (after the adjustment of the non-response) is still
shown to be significant, then the effect of non- response in our sample has no significant
effect on the result obtained.
Suppose r
1
is the ratio of prevalence of
suicidal ideation between the non-response and response groups in the
influence group and r
2
is the ratio of prevalence of suicidal
ideation between the non-response and response
groups in the non-influence
group. In the case of r
1
<1 or r
2
>1, the overall OR would
decrease. We assume that
r is 0.7, 0.6 or 0.5 (ie, the
prevalence in non-response group is 30-50% lower than that in the response
group)
1
and that r
2
is 1.3, 1.4 or 1.5 (ie, the
prevalence in the non-response group is 30-50% higher than that in the
response group).
Table 5 gives the estimated ORs in all scenarios that are found to be
significant. This result suggests that non-response bias is unlikely to alter
the result.
Table 5 Sensitivity analysis: estimated
OR under different assumptions about the ratio of the prevalence of suicidal
ideation between the non-response and response groups
Ratio
between the prevalence of suicidal ideation in the non-response and response
groups
|
Estimated OR
|
χ2 test
|
Being influenc ed by
celebrity suicide (r )
1
|
Not being influenced by celebrity suicide (r )
2
|
0.7
|
1.3
|
4.57
|
35.6, p = 0
|
0.7
|
1.4
|
4.33
|
34.1, p = 0
|
0.7
|
1.5
|
4.24
|
32.8, p = 0
|
0.6
|
1.3
|
4.28
|
31.6, p = 0
|
0.6
|
1.4
|
4.06
|
30.1, p = 0
|
0.6
|
1.5
|
4.06
|
30.2, p = 0
|
0.5
|
1.3
|
4.08
|
29.0, p = 0
|
0.5
|
1.4
|
3.87
|
27.6, p = 0
|
0.5
|
1.5
|
3.68
|
DISCUSSION
Age-gender-specific effect
Previous studies
on the effects of celebrity suicides or death were found to have
age-gender-specific effects on suicide. 2, 4 In this study, men aged 25-39 years were more
likely to be influenced. On analysing the profile of suicide cases immediately
after Cheung's death, men aged 25-39 years who committed suicide using the same
method as Cheung (ie, by jumping from a height) were found to have increased
significantly. 29
This
age-gender-specific effect can be explained by the fact that although Cheung
died at the age of 46 years, according to his fan club website (
http://lesliecheung.cc ), "a turning
point in his career" was the release of his album "Monica" in
1984 when he was 28 years. Teenagers at that time, who belonged to a generation
keen on pop music and aged between 25 and 39 years in 2003, were more likely to
identify with Cheung's behaviour.
Long-term influences
Most of the published studies assume that celebrity suicides or deaths
exert a short-term triggering impact on
people's suicidal thoughts. The effective period was from 2 to 4 weeks. 1, 2, 9 Some researchers
hypothesised that exposure to news of the suicide in the media might exert a
long-term effect on non-impulsive people and
"sow the
seeds of suicide in the distant future". 4 However, none of the current studies validated
this possibility of the long-term effects of celebrity suicide on suicidal
ideation.
In this
study, the time duration between the date of the celebrity suicide (1 April
2003) and the study period of suicidal ideation (between 1 December 2003 and 4
July 2004) was at least 8 months, and <15 months. This result outlines the
first population-based study, which reveals that celebrity suicide might lead
to a non- triggering and even long-term effect on people's suicidal ideation.
According to the observational learning theory, 30 an individual who had memorised the celebrity's
behaviour and had been sufficiently motivated could harbour suicidal ideation
even over a longer period of time. Thus, apart from the short-term effect shown
by previous studies, celebrity suicides that had drawn high public attention
might spur suicidal thoughts in those who had identified with and been
motivated by the celebrity.
Independent risk
for suicidal thought
Another
implication of this study is the evidence that the effect of celebrity suicide
is associated independently with people's suicidal ideation, even while the
known risk and protective factors for suicide are controlled.
Previous
published studies have assumed that a celebrity suicide has an effect mostly on
vulnerable people, who may be having depression or experiencing negative life
events. If this assumption holds true, then the effect of celebrity suicide on
suicidal ideation can be said to be mediated by those risk factors. However,
our findings indicate that the effect of celebrity suicide on people's suicidal
ideation was an independent risk. This means that celebrity suicide may trigger
suicidal ideation in anyone within the community, regardless of whether he or she were otherwise
vulnerable for suicide. Although there is only a relatively small percentage
(4%) of variance explained by celebrity suicide compared with 27% of variance
explained by other known risk factors, it is still important to be aware of the
possible negative effect.
What is already known
A celebrity
suicide or death is associated with a short-term increase in the suicide rate. Moderating
effect
Individuals' attributes such as
age, gender or suicidal history have also been shown to differentiate the
extent of the effect of media on suicidal thought. 4 However, little is known about how an
individual's psychological well- being or cognitive thinking plays a role in
this respect. Our findings indicate that having a greater level of anxiety
symptoms, less reason for living and more irrational values bolstered the
effect of celebrity suicide on suicidal ideation.
Positive effect
Some respondents
reported positive reactions to celebrity suicide-that is, suicide is less
acceptable than before. Our findings reinforced the notion that no one
displayed symptoms of severe suicidal ideation. This reflected the idea that
positive or healthy thinking after a celebrity suicide was a strong predictor
of not having severe suicidal ideation. Being less impulsive and having health
problems were found to be significant associated factors for this positive
reaction.
Implications
The Hong Kong
Chinese media reporting on suicides is truly exceptional, including many
graphics, photos or diagrams. It is not uncommon for a suicide report to appear
in the front page with sensational headlines. 31 This type of reporting does not comply with the
World Health Organization's recommendations on how to convey suicide news
coverage. In Hong Kong, guidelines for responsible reporting have been issued
for media professionals, and one of the key elements is to avoid sensational
portrayals of celebrity suicides. 32,
33
Our findings
comprised the first population-based study, which showed evidence on how the
influence of celebrity suicide is independently associated with a long-term
effect, rather than having a triggering effect on suicidal ideation. These
results have significant public health implications in that, apart from groups
that are vulnerable for suicide, a large group of otherwise non-vulnerable
people are also being exposed to potential harmful media influences. Issuing
media's recommendation in reporting suicide news and professional media
training are
needed to increase the media's awareness on the possible harmful after-effects
of suicides. 3, 34 Vienna's
case showed that the measures could reduce the suicide rate. 35 However, more research
should be done to evaluate the overall effectiveness of these recommendations.
What this study
adds
The results show
that the effect of a celebrity suicide is associated with suicidal ideation
over a longer term using information on an individual level rather than an
aggregated one.
The effect of a celebrity suicide is an independent risk
for suicidal ideation within the community.
Having more
anxiety symptoms, less reason for living and more reinforcement of irrational
values were found to bolster the effects.
Policy implications
These results
would have significant public health implications in that, apart from
vulnerable groups for suicide, a large number of non-vulnerable people will
also be exposed to the potential harmful effects of media coverage of suicides.
Issuing
media's recommendation and professional media training would be useful to
increase media's awareness on the possible harmful after-effects of extensive
reporting on celebrity suicide.
The public
should also be aware of the negative effects of celebrity death induced by the
mass media. However, more research should be done to understand the mechanism
in this area and to evaluate the overall effectiveness of some of the
preventive measures.
Limitations
The findings in
this study were subject to certain limitations. The data were obtained from a
cross-sectional design, which only indicates statistical association rather
than causation. Participants' self-reported data were subject to human error or
memory bias. Sensitive information such as a history of suicide attempts or
suicidal ideation might also have been under-reported. In this study, we did
not collect data on the level of exposure to a celebrity suicide or the
detailed characteristics of the celebrity. We are not aware of any incidence of
celebrity suicide that happened in the past few years, except Cheung's death.
It is unlikely that the respondent thought of another "celebrity
suicide" in this context, 8-15 months after an overwhelming incidence of
celebrity suicide.
There was a
memorial service a year after his death, which might also have affected the
respondents. But apparently, it did not generate media coverage comparable to
his death on 1 April 2003. According to an electronic news-clipping database,
there were only 157 news articles with his English name or Chinese name during
the period 2 April 2004 to 9 April 2004. This was compared with 1243 news
articles in 2003 during the same period 29 ; on 6 of the 8 days at least one newspaper
reported news of Cheung's death on the front page during the period 2 April
2003 to 9 April 2003. But none of those 157 articles in 2004 was printed on the
front page and the effect was expected to be minimal.
Acknowledgement: This research was supported by the Hong Kong Jockey
Club Charities Fund and the Chief
Executive Community Project. We thank Ms Ka Liu and the research team of the
Hong Kong Jockey Club Centre for Suicide Research and Prevention for their
valuable contributions to our research design, as well as for the
implementation of the prevalence study, and the many helpful suggestions from
Professor Ray Watson, the editor and
seven reviewers.
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Subjek: Self destructive behavior;
Studies; Suicides & suicide attempts; Risk factors; Lokasi: Hong Kong
Pengidentifikasi/kata kunci:
Epidemiologic studies Population-base studies Suicide (psychiatry) Suicide (public
health) ASIQ, Adult Suicidal Ideation Questionnaire BRFL, Brief Reasons for
Living VIF, Variance Inflation Factor
Judul: Long-term impact of celebrity
suicide on suicidal ideation: results from a population-based study Pengarang: Fu, King-wa; Yip, Paul S F
Judul publikasi: Journal of Epidemiology and
Community Health Volume: 61
Edisi: 6
Halaman pertama: 540
Tahun publikasi: 2007 Tanggal publikasi: Jun 2007 Tahun:
2007
Penerbit: BMJ Publishing Group LTD Tempat
publikasi: London
Negara publikasi: United Kingdom Subjek
publikasi: Medical Sciences ISSN: 0143005X
CODEN: JECHDR
Jenis sumber: Scholarly Journals Bahasa
publikasi: English
Jenis dokumen: Journal Article
Hak cipta: Copyright: 2007 Copyright 2007
Journal of Epidemiology and Community Health Terakhir diperbarui: 2016-04-07
Basis data: Public Health Database
